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Methadone and Suboxone: What’s the Difference Anyway?

An estimated 1.9 million people in the U.S. are addicted to prescription opioid drugs. Although there is no magical drug to treat opiate addiction, as part of a medication-assisted treatment (MAT) approach, there are a handful of treatment pharmaceuticals available on the market, including methadone, Suboxone, buprenorphine, and naltrexone. They are used to help you stop abusing harmful opiates (like heroin) and prescription opioids (like OxyContin) and return to a more stable and productive life.

Though these drugs that treat opioid dependence are successful in managing withdrawal and preventing relapse, they remain underused for a variety of reasons. One factor may stem from the fact that medication assistance is viewed by some as the mere replacement of one drug dependency for another.

Another reason is the potential that some of these treatment drugs have for misuse themselves. As opioid drugs, methadone, buprenorphine, and Suboxone all have some inherent abuse potential. Because of this, it’s important that you take these drugs exactly as they are prescribed.

So, if both methadone and Suboxone are both opioids used to manage opioid dependence, what’s the actual difference between the two?

Which Came First?

Methadone has a long history of treating opioid dependence since it was first introduced in 1937 in Germany. Within a few decades of its availability on the U.S. market—by the 1960s—it was being used in clinics to treat heroin dependency.

Suboxone is much newer to the treatment scene than methadone, having only been approved in 2002 by the Food and Drug Administration (FDA) to help treat opioid dependency.

How Do They Work?

Methadone changes the way the brain and the nervous system respond to pain in the body. It is used during detox because it reduces or eliminates the unpleasant symptoms of withdrawal.

Some methadone tablets can be swallowed and others, known as Diskets, are dissolved first in liquid. Methadone is also available as a liquid that is ready to drink, or that can be mixed with water or juice prior to being taken.

Buprenorphine is a synthetic opioid that produces weaker euphoric effects than say, heroin or methadone. Like methadone, it helps you during withdrawal because it reduces or eliminates your symptoms. There is also a relatively low risk of overdose when using buprenorphine.

Buprenorphine is available in 2 forms: the uncombined, generic form of the drug and Suboxone. Suboxone is a combination of buprenorphine with naloxone. Why the combination? One reason is that if you inject Suboxone, the naloxone will quickly give rise to very unpleasant and severe withdrawal symptoms, which will make you want to stop abusing the drug.

Suboxone comes in the form of a tablet and a dissolvable film that is placed under the tongue.

How Do I Get Them?

A doctor must prescribe methadone and you can only (legally) take the drug while under the supervision of a doctor. By law, methadone can only be dispensed at an opioid treatment program (OTP) which must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA).

Methadone is a Schedule II drug in the U.S., meaning it’s illegal to sell without a DEA license. Therefore, methadone maintenance treatment must be performed in a SAMHSA certified clinic.

Buprenorphine is a breakthrough drug because it is the first medication that can be prescribed and given to individuals right in a doctor’s office. According to the Drug Addiction Treatment Act of 2000, doctors can prescribe buprenorphine in a variety of settings including community hospitals, health departments, and prisons.

Want to hear something crazy? In 2013, Suboxone sales brought in $1.55 billion. That was more than sales were for Adderall and Viagra combined in that same year.

How Long Do I Need Them?

If you “dose” at an OTP, you will continue to show up at the clinic daily until your doctor thinks you are stable enough to take your methadone doses at home. You are recommended to stay on methadone for at least 12 months. However, depending on your situation, you may stay on treatment for years.

Once you are ready to stop using methadone you will slowly taper off the drug, and this will usually be done under medical supervision.

If you’re prescribed Suboxone, the amount of time you’ll need to take it will vary quite a bit. It’s really up to your treatment center and your individual history with substance abuse.

What If I’m Pregnant?

Methadone remains the gold standard of treatment medication if you’re pregnant and dependent on opioids. The benefits of the drug, despite its risks not being altogether ruled out, may outweigh the negatives and justify its selective use. Although there is no strong association between methadone use and birth defects, newborns may undergo some withdrawal shortly after birth if you have been taking it during pregnancy.

Buprenorphine has also not been shown to produce adverse effects during pregnancy. However, there are only a limited number of studies available. According to SAMHSA, in terms of buprenorphine use during pregnancy, “the risk of adverse effects has not been ruled out.”

Can They Be Misused?

As an opioid drug, methadone can be addictive. While it is obtained largely by prescription, methadone is also bought and sold on the black market. Over the years, prescriptions for methadone as a pain medication have increased and, perhaps unsurprisingly, so have deaths from overdose.

Because methadone is a long-acting opioid, its effects can build up in your body. According to the CDC, in 2009, 30% of all painkiller deaths were attributable to methadone. For deaths involving only one painkiller, methadone was involved in 4 out of every 10 deaths—twice as many as any other painkiller.

Buprenorphine, and therefore Suboxone, are not entirely safe either. In a 6-year study done in the UK, researchers recorded 2,366 deaths related to methadone and 52 related to buprenorphine. In terms of the risk to potentially overdose, researchers found buprenorphine to be 6 times safer than methadone.

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